Healthcare Policy: Recommendations to Achieve Better Quality, Efficiency, Resiliency and Access for Patients

Key Takeaways:

• Premier’s Healthcare Policy Roadmap includes recommended reforms aligned to four main public policy objectives.

• Read Premier’s full set of detailed recommendations in our Healthcare Policy Roadmap.

• We remain focused on engaging with policymakers to refine and enact meaningful policy solutions that make a difference for providers, their patients and communities.

New Year – new Congress.

The 2022 election resulted in narrow margins of victory with neither party having a clear political edge in a divided government. Yet even in the absence of a strong majority in the House and Senate, we believe there are a host of healthcare issues ripe for bipartisan backing over the next two years.

As the 118^th Congress commences, government leaders have an opportunity to coalesce around policy solutions to put America’s healthcare on track to achieve better quality, efficiency, resiliency and access for patients.

To chart a path forward, Premier is releasing a roadmap and recommendations designed to build on inroads made during the 117th Congress and to enhance the current framework for healthcare policy.

These recommended reforms are aligned to Premier and its members’ goals on four main public policy objectives – and designed with a bipartisan, holistic approach in mind:

• Optimizing the value of healthcare;
• Building resilient healthcare supply chains;
• Tech-enabling healthcare; and
• Eliminating gaps in healthcare.

What follows is a summary of Premier’s roadmap and recommendations.

Optimizing the Value of Healthcare

Policies that improve quality outcomes while safely reducing costs for patients are critical to strengthening and accelerating the ongoing transformation of healthcare.

To move the needle on value, policies must support providers’ engagement in innovative, value-based care models like accountable care organizations (ACOs) that are improving care and achieving savings, as well as providing regulatory flexibilities that allow care to take place in the setting most beneficial to the patient.

A range of bipartisan investments and policies can supercharge providers’ efforts to innovate and improve patient care and help ease the pandemic’s lingering effects that continue to impact many providers’ ability to stay fiscally viable. Namely, Congress and the Administration should work together to:

• Safeguard provider financial viability: Make providers whole by reimbursing at the cost of care – including accounting for the true costs of labor and providing a minimum of two years of relief from Medicare payment cuts so that providers can focus on longer-term strategic planning, care transformation and community reinvestment as they continue to navigate a post-pandemic environment.
• Advance value-based care: Extend the Advanced Alternative Payment Model (APM) incentive payments, ensure APM adoption metrics can be reasonably met and strengthen Medicare ACO programs to ensure that all providers have an equal opportunity to succeed.
• Improve Medicare Advantage (MA): Encourage MA plans to partner with providers in value-based arrangements, unleash the power of data and better align MA with other Medicare programs to improve patient outcomes and provider viability.
• Address labor challenges: Alleviate workforce shortages and burnout through greater investments in medical education and protections to support a violence-free and safe workplace, along with supportive immigration policies.
• Accelerate quality improvement: Advance next-generation quality programs by zeroing in on outcomes-based measures, social determinants of health and digital quality measurement.
• Ensure patient access to long-term care pharmacy services: Codify a statutory uniform federal long-term care (LTC) pharmacy definition to provide regulatory clarity around these highly specialized and distinct services for elder, vulnerable beneficiaries residing in LTC facilities.
• Support Hospital at Home program: Implement a permanent hospital at home program so that hospitals can continue to offer safe and effective alternative care for patients.

Building Resilient Supply Chains

The U.S. healthcare system continues to face the impacts of global supply chain challenges. While acute shortages of personal protective equipment (PPE) and other medical products have subsided, significant headwinds such as transportation delays, labor shortages and inflation mean that disruptions remain prevalent. At the same time, pharmaceutical marketplace dynamics stymie competition and impede patients’ access to lower-cost drugs and biologics.

Premier remains focused on addressing these challenges and driving innovation into the future. The federal government can play a key role in speeding the implementation of reforms to create a more transparent, diverse, competitive and reliable healthcare supply chain. Premier calls on Congress and the Administration to:

• Bolster pandemic preparedness: Take additional federal measures to prepare for the next pandemic by developing a national real-time, on-call supply chain data management system, strengthening the Strategic National Stockpile and ensuring supply chain integrity.
• Mitigate drug shortages: Strengthen the Food and Drug Administration’s (FDA) ability to proactively address and respond to potential shortages.
• Mitigate device shortages: Expand on the device shortage reporting requirements created in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
• Boost domestic manufacturing: Reduce overreliance on foreign manufacturers through tax incentives for domestic manufacturing, broaden and apply to private payors the current Medicare payment incentives for hospitals to purchase domestically manufactured critical medical supplies and pharmaceuticals, and redefine requirements for government purchasers to buy domestically.
• Incentivize competitive and healthy markets: Close regulatory loopholes that deter anticompetitive behaviors in the healthcare market, revise the Stark and Anti-Kickback laws to support value-based payments for devices and medications, and create transparency standards for Pharmacy Benefit Managers (PBMs).
• Advance environmental sustainability: Offer federal incentives to providers to drive greener choices for the safety and health of patients, workers and the environment. Additionally, Premier is committed to fulfilling the White House/HHS Health Sector Climate Pledge to reduce greenhouse gas emissions.

Tech-Enabling Healthcare

Ongoing reports of burned-out physicians, enormous health information technology system costs, clunky functionally, delayed care and data overload regularly remind us of the challenges providers continue to face in accessing usable data at the point of care.

Premier advocates for policies that enable technology to enhance patient safety and quality improvement, facilitate secure and timely communication and data exchange among healthcare stakeholders, and produce actionable and reportable data. By adopting the following, government leaders can help accelerate this new reality:

• Reduce the cost, harm and burden of the highly manual prior authorization process: Streamline prior authorization requirements under Medicare Advantage (MA), finalize federal standards for adoption of electronic prior authorization (ePA) and require MA plans to use ePA platforms to ensure timely beneficiary access to medically necessary care.
• Enable interoperability: Ensure providers’ access to actionable intelligence at the bedside through third-party applications, adoption of national interoperability standards and a patient identification/matching strategy, as well as provider access to claims and clinical data.
• Tighten cybersecurity: Strengthen FDA’s oversight of medical device cybersecurity, including its authority to hold manufacturers accountable for reducing medical device security risks and vulnerabilities.
• Enhance infection prevention: Establish federal incentives to increase EHR and Electronic Clinical Surveillance Technology (ECST) adoption among long-term and post-acute care providers to prevent and manage widespread infectious diseases.
• Expand telehealth: Permanently extend telehealth flexibilities to allow providers to continue to furnish services effectively and efficiently to patients remotely, including audio-only telehealth.
• Align data privacy requirements: Push for alignment of state and federal privacy laws with the Health Insurance Portability and Accountability Act (HIPAA) to avoid unintended threats to biomedical research and healthcare.

Eliminating Gaps in Healthcare

Both public and private sector organizations must work collaboratively to gain insights on underlying barriers to health equity and to tackle health disparities.

The lack of standardized outcomes measurement and collection of complete, actionable data on disparities, including for maternal mortality and morbidity, has been a persistent obstacle to reversing poor health trends and inequity in the U.S.

Premier advocates for policies that address disparities in healthcare experienced by vulnerable communities and populations. We urge lawmakers to address policies that close gaps in care access and improve healthcare delivery, including action to:

• Improve maternal-infant health: Leverage the Department of Health and Human Services’ (HHS) multi-year Perinatal Improvement Collaborative, which has tapped into Premier’s extensive data, to understand why disparate maternal outcomes occur and to inform policymaking action.
• Expand access in rural America: Ensure rural providers have the funding and flexibilities needed to continue providing high-quality, sustainable care in rural communities and address barriers to rural provider participation in APMs.
• Preserve Medicare patient access to home infusion: Codify clarifications to the Medicare Part B home infusion services benefit to appropriately reimburse home infusion providers.
• Advance health equity and social determinants of health: Using existing tools, advance standards for the collection of socio-demographic information to address the social determinants of health that might be getting in the way of patients achieving optimal health.
• Bolster treatment for behavioral health issues and substance use disorders: Leverage Premier data sources and analysis to support policymaking to improve access to critical behavioral health services.

Premier leverages robust data, large-scale collaboratives and experience working with thousands of U.S. providers to advance sound, evidence-based policies that improve healthcare in America. Based on unique-to-Premier insights, we surface to policymakers on-the-ground realities and common trends that providers across the nation face day in and day out.

Premier remains laser focused on engaging with Congress, the Administration and other industry stakeholders to refine and enact these recommendations for meaningful policy solutions that make a difference for providers, their patients and communities.